OCD is one of the leading causes of disability world-wide. Cognitive-behavioral therapy (CBT) consisting of exposure and ritual prevention (EX/RP) is an efficacious OCD treatment, but its effectiveness is limited by patient refusal, attrition, and/or poor adherence to the EX/RP protocol. For these EX/RP-resistant patients, EX/RP outcome is poor. Motivational Interviewing (MI) is a structured therapeutic method for enhancing motivation to change by exploring and resolving ambivalence. MI Interventions have been used successfully in alcohol abuse and other disorders to increase treatment entry, retention, and adherence and to enhance outcome in treatment-resistant patients. However, MI has not been systematically studied for EX/RP-resistant OCD patients. The goal of this Exploratory Research Grant (R34) is to develop and test an EX/RP+MI intervention aimed at increasing EX/RP entry, retention, and adherence in EX/RP-resistant OCD patients. Proposed as a collaboration between the Anxiety Disorders Clinic (ADC) and the Center for the Treatment and Study of Anxiety (CTSA), this project will build on our productive thirteen-year collaborative history, benefit from our established collaborative infrastructure, and exploit our cumulative expertise with OCD patients. If adding a brief MI intervention to standard EX/RP treatment substantially improves the outcome of EX/RP-resistant patients in the open trial proposed herein, these data will be used to support a larger controlled trial to confirm the efficacy of EX/RP+MI. If the EX/RP+MI intervention is effective, it could substantially impact public health by bringing the proven power of EX/RP to a much larger population of OCD sufferers. The specific aims of this Exploratory Research Grant (R34) are: 1) To integrate MI and EX/RP into a novel intervention (EX/RP+MI) for EX/RP-resistant OCD patients (i.e., patients who refused, dropped out, or partially adhered to prior EX/RP treatment). During Year 1, we will develop an EX/RP+MI manual based on our EX/RP expertise, training and consultation with an MI expert, and experience with 8 test cases. 2) To explore the efficacy of this novel EX/RP+MI intervention at improving OCD outcome in EX/RP-resistant OCD patients. During Years 2 and 3, we will conduct an open trial of this EX/RP+MI intervention in 24 EX/RP-resistant OCD outpatients who had a poor response to prior EX/RP treatment. [unreadable] [unreadable]